A New Method for Gain Calculation in Quantified Visuo-vestibular Interaction Test.

OBJECTIVE: To develop a new method to quantify visually-enhanced vestibulo-ocular reflex (VVOR) gain, in patients with vestibular function loss, that is mathematically suitable given the nature of the test, and determine the reliability of the method by comparing results with those of the gold standard, the video head impulse test (vHIT). MATERIALS AND METHODS: We developed a new method for VVOR gain quantification and conducted a cross-sectional study in patients diagnosed with vestibular function loss and controls, all participants undergoing both a VVOR test and a vHIT. We measured VVOR gain with three different methods: area under the curve (AUC), slope regression, and a Fourier method (VVORAUC , VVORSP , and VVORFR , respectively); and compared these gain values with vHIT gain calculated using the AUC method. RESULTS: Overall, 111 patients were included: 29 healthy subjects and 82 patients with vestibular function loss. Intraclass correlation coefficients (ICC(1,1)) between gain from the gold standard and each of the VVOR gain methods were: 0.68 (CI: 0.61-0.75) for VVORAUC , 0.66 (CI: 0.58-0.73) for VVORSP and 0.71 (CI: 0.64-0.77) for VVORFR . No interference was found between VVOR gain calculation methods and potentially influential variables considered (p ≥ 0.98). CONCLUSION: The new method for quantifying VVOR gain showed good concordance with the vHIT method. LEVEL OF EVIDENCE: 2: Individual cross-sectional studies with consistently applied reference standard and blinding (Diagnosis) Laryngoscope, 133:3554-3563, 2023.

Manejo quirúrgico del hiperparatiroidismo primario con pruebas de localización prequirúrgicas negativas / Surgical management of primary hyperparathyroidism with negative preoperative imaging workup

Introducción y objetivo: Una vez realizado el diagnóstico de hiperparatiroidismo primario (HPTp), el único tratamiento curativo posible es la paratiroidectomía. Puede llevarse a cabo mediante una exploración cervical bilateral o por medio de una paratiroidectomía mínimamente invasiva (MIP), en la que exclusivamente se explora el compartimento cervical en el que se encuentra la glándula paratiroides sospechosa de causar el HPTp. Los resultados de ambas técnicas son comparables, existiendo una mayor tendencia a realizar MIP cuando en las pruebas de localización de imagen se localiza correctamente la glándula afecta. En el caso de que las pruebas de localización resulten negativas o discordantes el tipo de abordaje quirúrgico es controvertido. Método: Se realizó una revisión sistemática de artículos originales, guías, y documentos de sociedades científicas dedicadas al manejo del hiperparatiroidismo primario que incluían casos con pruebas de localización contradictorias o negativas. Se localizaron 211 estudios y finalmente se seleccionaron 2 revisiones sistemáticas, 20 estudios originales y 4 guías de recomendaciones de sociedades profesionales.Discusión: La recomendación formal de las guías es realizar una BNE en los casos de pruebas de localización negativa. En el resto de la literatura revisada se observó una tendencia creciente de los cirujanos a solicitar pruebas de localización complementarias para intentar una MIP, aunque la mayoría seguían la recomendación de las guías. Algunos autores han reportado tasas de éxito de MIP con medición intraoperatoria de PTH similares a los obtenidos con BNE. Técnicas como el PET-TC con 18F-fluorocolina o 11C-colina, la cirugía radioguiada con gammacámara y la medición intraoperatoria de PTH, son de especial utilidad en el estudio prequirúrgico y como apoyo durante la cirugía de casos con pruebas de localización negativas. (AU)

Introduction and objective: Once the diagnosis of primary hyperparathyroidism (pHPT) is made, the only curative treatment available is parathyroidectomy. This can be achieved by a bilateral neck exploration or through a minimally invasive parathyroidectomy, in which the only neck compartment explored is the one suspected of having the parathyroid gland causing the pHPT. The results of both techniques are equivalent. However, there is a growing tendency to choose MIP when imaging studies correctly localize the affected gland. When imaging studies are negative or discordant, surgical management causes some controversies. Method: We performed a systematic review of original articles, guidelines and scientific socie-ties documents related to the management of primary hyperparathyroidism with contradictory or negative preoperative localization. We found 211 studies, and selected 2 systematic reviews, 20 original articles and 4 guidelines. Discussion: Guidelines recommend performing a BNE when preoperative localization fails. In the reviewed literature we observed a growing tendency of requesting further imaging studies to perform a MIP, although the majority of surgeons follow the guidelines. MIP + intraoperative PTH monitoring has been reported to have similar success rates as BNE. Some techniques like 18F-Fluorocloline or 11C-coline PET-TC, radioguided surgery with intraoperative gamma camera and intraoperative PTH monitoring, are especially useful in the preoperative workup and as support during surgery when localizing imaging tests result negative. (AU)